Weight Recidivism and Dumping Syndrome after Roux-En-Y Gastric Bypass: Exploring the Therapeutic Role of Transoral Outlet Reduction

Abstract

Obesity is a chronic, relapsing disease representing a global epidemic. To date, bariatric surgery is the most effective treatment for morbid obesity in the long-term. Roux-en-Y gastric bypass (RYGB) is one of the most performed bariatric interventions, with excellent long-term outcomes. However, about one-third of patients may experience weight regain over time, as well as dumping syndrome. Both these conditions are challenging to manage and require a multidisciplinary and personalized approach. The dilation of the gastro-jejunal anastomosis is a recognized etiological factor for both weight regain and dumping syndrome. Dietary modifications, behavioral interventions, and medications represent the first therapeutic step. Revisional surgery is the traditional approach when non-invasive treatments fail. However, re-interventions may be technically difficult and are associated with increased morbidity and mortality. Transoral outlet reduction (TORe) is an endoscopic procedure aimed at reducing the size of the anastomosis and is proposed as a minimally invasive treatment of weight regain and/or dumping syndrome refractory to conservative therapies. This review is aimed at providing a narrative overview of the role of TORe as part of the multidisciplinary therapeutic toolkit nowadays available to approach weight regain and dumping syndrome after RYGB.

Challenges of Revisional Metabolic and Bariatric Surgery: A Comprehensive Guide to Unraveling the Complexities and Solutions of Revisional Bariatric Procedures

“…This adverse event not only poses challenges for long-term weight management but also necessitates comprehensive strategies for monitoring and intervention to mitigate its effects on health outcomes. WR has been associated with several factors, including behavioral, psychological, and anatomical factors, such as the dilation of the GJA which leads to a faster gastric emptying and a reduced sense of satiety [ 90 ].…”

“…Re-interventions can pose technical challenges attributed to adhesions and altered anatomy. Furthermore, these reoperations entail a higher risk of complications, morbidity, and mortality in comparison to the primary procedure [ 90 ]. According to a newly published report detailing our institution’s experience, late adverse events such as anastomotic stricture were the most common causes of surgical revision, in patients who underwent RYGB as their index procedure, rather than IWL [ 85 ].…”

Dumping Syndrome: Pragmatic Treatment Options and Experimental Approaches for Improving Clinical Outcomes

“…After RYGB surgery, endoscopic therapy may help to reduce the diameter of a dilated or incompetent gastrojejunal anastomosis in order to delay gastric pouch emptying. In the literature, this procedure is referred to as transoral outlet reduction (TORe), [68][69][70] or endoscopic gastrojejunostomy revision (EGJR), or revision of the gastrojejunal anastomosis (GJA). [71][72][73][74] A systematic review to evaluate the effects of this technique included 6 studies, of which only 1 was prospective while the others were retrospective reports.…”